Provider Demographics
NPI:1790053981
Name:LAKES INTERVENTIONAL RADIOLOGY CORP
Entity Type:Organization
Organization Name:LAKES INTERVENTIONAL RADIOLOGY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-433-1335
Mailing Address - Street 1:16853 NE 2ND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1776
Mailing Address - Country:US
Mailing Address - Phone:305-907-6191
Mailing Address - Fax:305-907-6192
Practice Address - Street 1:1380 NE MIAMI GARDENS DR STE 240
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4750
Practice Address - Country:US
Practice Address - Phone:305-907-6191
Practice Address - Fax:305-907-6192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0204X
FLOSR807261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty